2B or Not 2B: Flying In the Age of Innocence

Dec 12, 2009 - 5 comments

2B or Not 2B: Flying in the Age of Innocence
Missouri Medicine Editorial #12
John C. Hagan III, MD

“Is there is a doctor on the plane? Please come to the First Class cabin”
I’m an Ophthalmologist, in a plane 30,000 feet over the Atlantic Ocean, returning from a much needed winter vacation. It’s 1995, the world and air travel were different then.
We’re halfway between Puerto Rico and our Miami destination. There are more than 200 people aboard this Boeing 747. I’m rapidly calculating the odds that there’s an Emergency Medicine specialist or Internist on board.
The announcement is repeated, a little more urgent, the voice noticeably more desperate.
“We need a doctor in first class. Pause. The female announcer draws a deep breath. Any kind of doctor will do.”
Heads are turning expectantly back in cattle-class where my wife and I are traveling. As yet, no Good Samaritan has stepped forward from the hoi polloi. The woman on my left murmurs, “I’m a registered beautician. I worked one summer as a lifeguard. Maybe I should see if I can help.”
It occurs to me that if someone is drowning in a martini or having a bad hair day, she would be just the ticket.
“John, you have to go. There’s no other doctor on the plane,” my wife opines. I have reluctantly arrived at the same conclusion.
Marshalling my best bravado and sang froid, I head for the First Class cabin. Rapid pulse, perspiration, dilated pupils-I exhibit all the symptoms of a full-blown “fright on flight” reaction. Bladder and bowel control suddenly become an issue.
More eyes than I examine in a week follow me down the aisle. Bits of conversation catch my ear.
“Why did he wait so long to stand up?”
“Maybe he’s hard of hearing.”
“Maybe he’s a pathologist.”
After what seems like a mile and a half, I reach the front of the plane.
There I meet the flight attendant with the edgy voice.
“I just can’t understand it. We always have a doctor in First Class. We never have to go back there in an emergency”.
This elitist flight attendant whom I dub ‘Queen B’ has spent too much time in first class. The caviar fumes have damaged her brain.
Why are there no physicians traveling First Class? She understands nothing about doctors’ favorite oxymoron-Medicare reimbursement.
“You’re a doctor?”, Queen B asks suspiciously.
“Yes, I’m an Ophthalmologist.”
“Well you’ll have to do. The man in 2B is having chest pain.”
I was really hoping for a corneal abrasion or a hard to remove contact lens.
I try to recall all the specifics of cardio-vascular resuscitation. Just as I’m ready to order boiling water and clean sheets, I remember that’s only for obstetrical emergencies in cowboy movies.
2B is a man in his 70’s. Like his attending physician, he is gray and sweaty.
2B’s wife, 1B, says her husband has angina. They ran through the San Juan airport to catch the flight.
It’s been a long time since I managed a chest pain patient. Do I apply leeches or ‘bleed him’? Just kidding- hasn’t been that long.
“Where are his medications? ”, I ask.
“Up there,” says 1B, pointing to the overhead storage, “in our carry-on luggage.”
I stand up to open the overhead bin.
“Careful” Queen B says sharply, “shift happens!”
Chastised, I carefully retrieve 2B’s medications.
After some oxygen and nitroglycerine, 2B is pink and his chest pain has abated. He expresses an interest in lunch. I realize I’m the only passenger that’s still gray and sweaty.
I’m about to ask 2B to share the oxygen when Queen B says the Captain wants to see me. I’m escorted to the cockpit door, which opens after a series of knocks and a code word.
Queen B introduces me to the Captain. “This is the doctor, (pause) but he’s an eye doctor (zing)”
I step inside the cockpit. “Wow” I gush, “what a great view you guys have up here.”
“That’s why we drive it from up here, doc.”
I realize I have just blurted out a candidate for the Inane Comment Hall of Fame.
The captain wants to know the details. I tell him things are going well, 2B has probably only had an angina attack and he seems to be back to normal.
He thanks me. Queen B asks me to return to my seat and reminds me to fasten my seat belt.
As I retreat through First Class I notice how much more appetizing the food looks. Back in coach, cold ‘mystery chicken’ awaits me.
I find 2B off oxygen and enthusiastically discussing wine selection with 1B.
“Thanks for the help, doc. My wife could never have got those medications out of our carry-on without you. Are you really an eye doctor?”
“Yes, I’m an Ophthalmologist”
“Do you have one of those little tiny screwdrivers that tighten glasses frames? Mine are kind of loose.”
“No,” I say, “I’m on vacation and traveling light.”

Remember that oxygen us always available at every passenger position, in limited quantities. The oxygen is not carried in a tank, as is the case in a hospital environment. Instead the oxygen is produced by an "oxygen candle" that produces oxygen by means of a chemical reaction. When the oxygen mask falls down, the candle is not activated. The mask must be pulled hard, which activates an igniter that starts the candle. The stewardess should have done this immediately, however they are very reluctant to do anything not covered by their training. A single candle is not enough to sustain a patient with breathing difficulties over a long transatlantic flight, but by moving to another seat, you can pull down another mask and ignite a different candle.

If you want humor, decades ago I was flying a jet air ambulance. Because the company was cheap, we didn't get paid unless we went "gear up". One day we were contracted to fly an elderly gentleman who wanted to die "at home" half a continent away. Six hours flying time there and six hours back! That was going to buy a lot of beers! Things were slow and we hadn't turned a wheel in six days! The plane had been polished and polished and polished.......

I filed IFR, and the turbines were spinning. The patient was at the air-stair, accompanied by Nancy Nurse. She was cute, blond, amply endowed and I had dreams of sugarplums dancing in my head.

The wheelchair was just at the bottom step.

Just then the nurse climbed into the cabin, worked her cute butt to the cockpit and announced "I'm sorry. The patient just died!"

The pilot (I was co-pilot) had just had a nasty divorce and was deeply in debt.

"Put him on the plane!" he ordered. "He isn't gonna die on this (censored) airport!"

To my dismay he left his seat and went back, down the stairs, and, with great effort, manhandled the corpse up into a seat.

The nurse was aghast!

He pulled up the airstair and ordered the puzzled nurse to "strap yourself in".

The power levers moved forward and we were soon at the end of the active.

As we went wheels up enroute to California he mumbled:

"I got rent to pay, ya, know..."

When we landed and I suggested to the nurse we might go out for dinner...she screamed:

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